Healthcare Provider Details

I. General information

NPI: 1912409475
Provider Name (Legal Business Name): MOYES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 S MULBERRY ST
JACKSON GA
30233-2058
US

IV. Provider business mailing address

PO BOX 580
MCDONOUGH GA
30253-0580
US

V. Phone/Fax

Practice location:
  • Phone: 770-957-5561
  • Fax: 678-792-4866
Mailing address:
  • Phone: 770-474-7693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE010428
License Number StateGA

VIII. Authorized Official

Name: LOREN PIERCE
Title or Position: CEO/OWNER
Credential:
Phone: 770-474-7693